Medicare CPT Coding Rules for Speech-Language Pathology Services

This page contains important Medicare policies related to CPT coding for services rendered by speech-language pathologists, including a complete list of CPT codes and any relevant special coding rules. While these rules are set by the Centers for Medicare & Medicaid Services (CMS), they are often adopted by other third party payers. SLPs should also verify payment rules with their local Medicare Administrative Contractor.

Designation of Time

Most CPT/HCPCS codes reported by speech-language pathologists are "untimed" (i.e., they do not include time designations). An untimed code is billed as a session without regard to time. Exceptions for Medicare-covered codes are

Note: A timed code is billed only if face-to-face time spent in an evaluation is at least 51% of the time designated in the code's descriptor. An exception is 96125 where allowable time includes interpretation of test results and preparation of the report.

Code Modifiers

Untimed CPT codes represent "typical" visit lengths or times to conduct a typical test unless the time is specified in the CPT descriptor. For significantly atypical procedures, a "-22"modifier can be used to indicate that the work is substantially greater than typically required and a "-52"modifier for an abbreviated procedure. Modifier "-22" should not be used frequently because the Medicare contractor could make the determination that the procedure reflects typical service delivery. For claims with the "-22" modifier a description of the need for extended services should accompany the claim. Modifier "-59" is used to establish one procedure as distinct from another procedure billed on the same day.

Part B services provided under plans of care for speech-language pathology or dysphagia services require a GN modifier as a suffix to the CPT code. The requirement applies to physician offices as well as facilities and private practices. Occupational therapy and physical therapy modifiers are GO and GP, respectively. For therapy services that exceed the annual therapy cap, a -KX modifier is required, indicating services are medically necessary and the documentation is available for review.

Same-Day Billing Restrictions

Use of Physical Medicine Codes (97000 Series)

CMS staff have concluded that speech-language pathologists should not report physical medicine codes 97110 (Therapeutic exercises, each 15 minutes) and 97112 (Neuromuscular reeducation, each 15 minutes). Although CMS has not issued a formal policy statement regarding this issue, agency officials have stated their position, based on the official descriptors and vignettes for the codes. Please note that cognitive therapy (97532) and sensory integration (97533) by speech-language pathologists are covered in all Medicare Local Coverage Determinations (LCDs). Some Medicare contractors may allow exceptions in Local Coverage Determinations.

CPT Codes & Special Medicare Rules for SLPs

Note: CMS requires that the "-GN" modifier be added to every code that is rendered under a speech-language pathology or dysphagia plan of treatment. [-GO indicates occupational therapy; -GP indicates physical therapy]

CPT Code

Descriptor

Special Medicare Rules

31579

Diagnostic laryngoscopy with stroboscopy

Effective Oct. 1, 2011, this code can be billed by independent SLPs without supervision, unless supervision is determined by state law or regional Medicare Administrative Contractors. For more information, see ASHA's FAQs on this matter.

Includes training & modification of voice prosthetics. [1]Medicare directs SLPs to use 92507 for auditory rehabilitation.

92508

Group, two or more individuals

Generally limited to 4 individuals. Limit of 25% of total SLP tx sessions is applicable to Part B patients in some intermediary Local Coverage Determinations. (For SNF Part A residents, up to 25% of each discipline's rehabilitation tx minutes per week.) [2]

Effective Oct. 1, 2011, this code can be billed by independent SLPs without supervision, unless supervision is determined by state law or regional Medicare Administrative Contractors. For more information, see ASHA's FAQs on this matter.

There is no dysphagia group tx code. Medicare payers may accept 97150based on section 15/230.A of the Medicare Benefit Policy Manual) or 92508 for dysphagia group tx. Please contact your local intermediary or carrier for further guidance. [3]

Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech

Under Medicare, applies to tracheoesophageal prostheses (e.g. Passy-Muir Valve), artificial larynges, as well as voice amplifiers. Use 92507 for training and modification of voice prostheses. [4]

92605

Evaluation for prescription for non-speech generating AAC device, face-to-face with the patient; first hour

CMS previously instructed SLPs to use 92506 for this service. [5]Because 92506 has been deleted, CMS officials state that non-SGD services (evaluation and treatment) are considered "bundled" (i.e., not separately billable) and are captured under any other service the SLP provided that day (e.g, 92523 or 92507). ASHA and CMS are investigating alternatives for those times an SLP would provide a non-SGD service alone. Currently, this would not be billable under CMS' interpretation.

92618

Evaluation [92605], each additional 30 minutes

This is an add-on code for 92605.

92606

Therapeutic services for use of non-speech generating devices, including programming and modification

CMS previously instructed providers to use 92507 for non-SGD therapy [6], CMS has since provided different instruction. See 92605.

92607

Evaluation for prescription of speech-generating AAC device, first hour

SGDs generate synthesized or digital speech. Include -52 modifier if less than one hour. [7]

92608

Evaluation [92607], each additional 30 minutes

May be reported for evaluation spanning multiple days[8]. Billing must occur in conjunction with 92607 on the claim form and should be submitted using the last date of service. Do not bill 92608 separately from 92607.

92609

Therapeutic services for use of speech-generating device, including programming and modification

Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.

If billed on the same day as 92521-92524, documentation should explain the need for the cognitive evaluation in addition to the speech-language evaluation.

Developmental testing, with interpretation and report, per standardized instrument form

Medicare-specific code to be used instead of 96110.

Other CPT Codes of Interest to Speech-Language Pathologists

These procedures are generally not considered to be SLP codes although some may be performed by speech-language pathologists or in collaboration with physicians. Some Medicare payers may allow payment of the listed 97000 series codes performed solely by the speech-language pathologist.

CPT Code

Descriptor

Special Medicare Rules

70371

Pharyngeal and speech evaluation, by cine or video

Radiologic procedure included here for information purposes and not for billing by SLPs.

74230

Swallowing function, with cineradiography/videoradiography

Radiologic procedure included here for information purposes and not for billing by SLPs; is reported with 92611. 92610 is usually reported prior to this procedure.

[3] Sec. 15/230.A of the Medicare Benefit Policy Manual: Group Therapy Services. Contractors pay for outpatient physical therapy services (which includes outpatient speech-language pathology services) and outpatient occupational therapy services provided simultaneously to two or more individuals by a practitioner as group therapy services (97150). The individuals can be, but need not be performing the same activity. The physician or therapist involved in group therapy services must be in constant attendance, but one-on-one patient contact is not required.

The ASHA Leader

﻿

ASHA Corporate Partners

﻿

About Us

The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 182,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students.